Ill-Defined Radiolucency; Left Posterior Mandible and Ramus

This is a 13-year-old white male who presented for an emergency exam of a large swelling in the left posterior mandible and ramus area.

Diagnostic Information Available

History of present Illness

This is a 13-year-old white male who presented for an emergency exam of a large swelling in the left posterior mandible and ramus area. The clinical examination revealed a palpable mass that was slightly painful and was described to have intermittent bleeding episodes. Teeth #s 18 & 19 were slightly mobile. Patient states the problem started shortly before the braces were placed and the problem became worse after the braces were placed. Panoramic radiograph showed an ill-defined radiolucency involving the posterior mandible (teeth #s 17-19) extending superiorly into the ramus (Figure 1). The past medical history is negative.

Figure 1. Panoramic radiograph taken at first clinical presentation. Note the ill-defined radiolucency in the posterior mandible extending superiorly into the ramus. Also note the bone loss around teeth #s 18 & 19.

Medical History

The past medical history is negative.

Clinical and Radiographic Findings

Clinical examination revealed a large mass of soft tissue in the left posterior mandible around teeth #s 17-19. Teeth #s 18 & 19 were slightly mobile. The mass was found to be associated with destructive bony lesion (Figure 1) involving teeth #s 17-19 and extending superiorly into the ramus.

Figure 1. Panoramic radiograph taken at first clinical presentation. Note the ill-defined radiolucency in the posterior mandible extending superiorly into the ramus. Also note the bone loss around teeth #s 18 & 19.

Excisional Biopsy

Treatment

Under intravenous anesthetic an incision was made over an intact buccal cortex. An incisional biopsy was performed and the tissue submitted for microscopic evaluation.